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NPI Code Detail

MEDICARE: MRS. LUCY ANNE TILLETT RN, CNS

MEDICARE: MRS. LUCY ANNE TILLETT RN, CNS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364SA2200XAdult Health Clinical Nurse SpecialistOR

General Provider Information

NPI Number : 1639255722
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LUCY ANNE TILLETT RN, CNS
Provider Business Mailing Address
First Line : 2724 NE DUNCKLEY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97212-1644
Country : US
Telephone Number : 503-869-1627
Fax Number : 503-488-5852
Provider Business Practice Location Address
First Line : 2724 NE DUNCKLEY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97212-1644
Country : US
Telephone Number : 503-869-1627
Fax Number : 503-488-5852
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 07/08/2007

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